From 22-23 June 2015, approximately two dozen emerging leaders from across West Africa in research, academia, health ministries and civil society gathered at the University of Ghana School of Public Health to discuss, debate and dream about the growing field of health policy and systems (HPS) in the region, and their place in it. Nine countries (both Francophone and Anglophone) were present: Benin, Burkina Faso, Cote D’Ivoire, the Gambia, Ghana, Mali, Niger, Nigeria and Senegal.
While the purpose of the gathering was to continue the consultative process of a planning phase to strengthen in-country capacities for HPS regionally (a project supported by the West Africa Health Organisation, the University of Ghana, and the International Development Research Centre), the outcome was so much more. Since previous consultations had repeatedly raised the issue of how to engage junior researchers and practitioners ‘more and better’, this meeting was crucial in allowing a small group of them to self-organise and voice their concerns, ideas and hopes about the shape of things to come in terms of how the HPS field can develop in West Africa. This is no small matter given West Africa has many of the lowest development indicators. Improving these indicators – and the complex stories behind them – is made complicated in a region of fifteen ECOWAS (Economic Community Of West African States) countries (plus three additional island countries), three ‘official’ languages (not to mention hundreds of others) and approximately 245 million people. Historical, political and economic contexts increase the urgency for home-grown, locally-driven and locally-used solutions for better health policies and evidence.
The meeting aimed for ‘connectivity’ and linked several colleagues in by skype from locations as diverse as Sydney, Abuja and Ottawa. We also tweeted (#AccraHPSR2015), and a Facebook page is underway. Coverage of the event was great and helped to raise the meeting’s profile and the need for such types of fora.
One key outcome of the meeting included the establishment of an embryonic network to allow this group to speak across languages. This is not simply an issue of linguistics, but is also about philosophical, cultural and paradigmatic differences in approach. Consciously building a network which seeks to bridge these gaps is a first step in breaking down silos. The tangible outcome of the meeting, however, was a prioritised set of key issues – from the perspectives of emerging leaders – for West African HPS. While the discussions were rich, wide ranging, and reflected the wealth and diversity of participants’ experience, the main themes could be distilled into a few main threads:
Better writing: how can we ‘popularise’ what we do, better? Academic (and for that matter policy) writing is necessary but can often be dry – and there are other ways of sharing what we do. We can learn by spending time with journalists and even NGOs to better story-tell and advocate as a core part of our work. An example told from the early days of the Ghana Health Service showed how young people with journalism backgrounds had been recruited and trained in health research. Many of them went on to become leading researchers, working closely with various institutions in the health sector, and thus helping to solidify the evidence-to-policy practice in Ghana. Other excellent examples came from Nigeria (with its tradition of great writers), including the more recent Nigeria Health Watch.
Balancing numbers: how do we ensure that there are as many colleagues from outside the universities and research institutes engaging in HPS? While ministries of health are the usual source of practitioners, we must remember that health issues exist in other sectors, in civil society, and even ‘big P’ politics. The only way we can co-produce knowledge and evidence for health action is if we are exposed to the same trainings and opportunities to learn and grow together (i.e., becoming friends now so we can be friends later).
Mentorship and mindset: there was a lot here. It began with reflections on being aware of our own learning needs and actively seeking out those who could contribute to our development. These are not necessarily our current or immediate superiors. Rather than focusing on technical skills, the discussions centred more on ‘softer skills’ of leadership, political negotiation and advocacy, and teamwork traits of harmony, humility, trustworthiness and credibility. Importantly, the discussion also moved forward thinking about attracting, exposing and sustaining the next generation of “HPSers”, and therefore developing mentorship capacities in ourselves. This led Professor Irene Agyepong to share this particular wisdom: that in a social field where relationships with everyone matter, understanding our personal interest in others is important. Whether we perceive the light of a night sky as a “single moon or a thousand stars” will affect our own decisions about how we lead – and that the attitudes with which we ‘emerge’ will have implications for the next generation. Powerful.
The meeting was made particularly special by the presence of several ‘emerita leaders’ from the Ghanaian health sector who had played diverse and critical roles in sectoral reforms and establishment of key health institutions over the past 30 years. This facilitated a precious exchange, and underscored the fact that as we press into the future we cannot be history-illiterate; there are lessons to be remembered and re-learned.
The ‘how’ of it all remains: putting into practice many of these ideas – including setting up regional hubs, conducting joint research, networking institutions and not just people – will take time, commitment and money. But we are in it for the long-haul, because we want to build and inhabit our own home. We welcome as many as want to join us to come – the night sky is vast, and the stars innumerable.
Aku Kwamie: University of Ghana School of Public Health, Ghana
Abubakar Kurfi: National Health Insurance Scheme, Nigeria
Enyi Etiaba: College of Medicine, University of Nigeria, Enugu Campus, Nigeria
Felix Obi: Health Reform Foundation of Nigeria
Seye Abimbola: National Primary Health Care Development Agency, Nigeria/School of Public Health, University of Sydney, Australia